Martínez-Ródenas F, Oms L M, Carulla X, Segura M, Sancho J J, Piera C, Fernández-Espina M R, Sitges-Serra A
Department of Surgery, Hospital Universitario del Mar, Barcelona, Spain.
Br J Surg. 1989 May;76(5):461-4. doi: 10.1002/bjs.1800760512.
To elucidate the pathogenesis of renal insufficiency associated with obstructive jaundice we have studied spontaneous water intake and body water compartments in rabbits undergoing common bile duct ligation. Total body water, extracellular water and plasma volume were measured by multi-isotope dilution technique. During the initial 6 postoperative days spontaneous water intake was 898 ml in sham operated animals (SO) but only 280 ml in jaundiced rabbits (OJ6) (P less than 0.01). Creatinine clearance was almost unchanged in SO but fell to 60 per cent of the preoperative values both in OJ6 and in paired-drink sham operated animals (SO2). There was a 15 per cent decrease in total body water (P less than 0.01) and a 24 per cent decrease in extracellular water (P less than 0.01) 6 days after bile duct ligation. There was a further reduction of the extracellular water to 35 per cent and a 15 per cent reduction of plasma volume 12 days after ligation. Water restriction mimicked the alterations in body composition produced by bile duct ligation. We conclude that bile duct ligation is associated with hypodypsia and a depletion of extracellular water and plasma volume. These alterations could explain the tendency to develop hypotension and renal failure which are associated with obstructive jaundice.
为阐明梗阻性黄疸相关肾功能不全的发病机制，我们研究了接受胆总管结扎的家兔的自发饮水量和身体水分分布。采用多同位素稀释技术测量全身水、细胞外液和血浆容量。术后最初6天，假手术动物（SO）的自发饮水量为898毫升，而黄疸兔（OJ6）仅为280毫升（P<0.01）。假手术动物的肌酐清除率几乎未变，但在OJ6组和配对饮水假手术动物（SO2）中均降至术前值的60%。胆总管结扎6天后，全身水量减少15%（P<0.01），细胞外液减少24%（P<0.01）。结扎12天后，细胞外液进一步减少至35%，血浆容量减少15%。限水模拟了胆总管结扎引起的身体成分变化。我们得出结论，胆总管结扎与饮水减少以及细胞外液和血浆容量减少有关。这些变化可以解释梗阻性黄疸相关的低血压和肾衰竭倾向。
